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General NPI Number Information
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NPI Number | 1295691764
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Entity Type | Individual
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Provider Name | CAMILLE SUZANNE WOLFE
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Gender | Female
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 840 E PRIMROSE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5254
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Country | US
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Telephone | 417-771-9414
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Fax |
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Provider Business Mailing Address
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Address Line | 1806B W WASHITA ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-406316
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License Number State | MO
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